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Modified device-free HAL: an innovative cost-reductive approach.

Manickam Ramalingam1, Kallappan Senthil, Mizar G Pai

  • 1Department of Urology, PSG Institute of Medical Sciences and Research, Coimbatore, India. uroram@yahoo.com

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|September 15, 2009
PubMed
Summary

This study introduces a low-cost, device-free hand-assisted laparoscopy (HAL) technique using a double glove and sponge. This innovation makes valuable HAL benefits accessible in resource-limited settings for procedures like nephrectomy.

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Innovation
  • Urologic Procedures

Background:

  • Hand-assisted laparoscopy (HAL) offers significant surgical advantages, including tactile feedback and easier specimen retrieval.
  • High costs of conventional HAL devices limit their adoption in developing countries.
  • There is a need for cost-effective HAL solutions to improve surgical care globally.

Purpose of the Study:

  • To describe a novel, device-free hand-assisted laparoscopy (HAL) technique.
  • To evaluate the feasibility and application of this low-cost HAL method in nephrectomy and nephroureterectomy procedures.
  • To demonstrate how to overcome the economic barriers associated with HAL in resource-limited settings.

Main Methods:

  • A modified HAL approach was developed using a double glove with an intervening sponge as an obturating cuff at the wrist.
  • A muscle-splitting incision in the iliac fossa was employed to minimize air leakage.
  • The technique was applied to perform nephrectomy and nephroureterectomy surgeries.

Main Results:

  • The device-free HAL technique successfully facilitated specimen removal and dissection.
  • The modified obturating cuff and incision approach effectively managed pneumoperitoneum.
  • The procedure was found to be a viable, cost-effective alternative to standard HAL.

Conclusions:

  • Device-free HAL is a practical and affordable solution for developing countries.
  • This technique retains key HAL benefits, enhancing surgical capabilities in resource-limited environments.
  • The described method offers a promising avenue for expanding minimally invasive urologic surgery globally.